From the Guidelines
Sacral neuromodulation is a highly effective treatment for urinary retention, fecal incontinence, and female sexual anorgasmia, with success rates ranging from 60-80% for urinary and fecal issues, and promising results for sexual function improvement. This therapy involves implanting a small device that sends mild electrical pulses to the sacral nerves, which control the bladder, bowel, and pelvic floor muscles, and can be effective for these conditions when other treatments have failed 1. For urinary retention, sacral neuromodulation can help improve bladder emptying, while for fecal incontinence, it can enhance bowel control, as shown in a study where 36% of patients reported complete continence and 89% were deemed a therapeutic success after 5-year follow-up 1. The procedure typically involves a test phase with a temporary external device for 1-2 weeks, followed by a permanent implant if successful, and patients use a handheld programmer to adjust stimulation levels. Some key points to consider include:
- Success rates vary but are generally high for urinary and fecal issues
- Improvement for sexual function is less well-studied but promising
- The device requires periodic battery replacement and may interfere with MRI scans
- Side effects are usually mild and can include pain at the implant site or changes in stimulation sensation
- Sacral neuromodulation works by restoring normal nerve function and communication between the brain and pelvic organs, helping regulate muscle contractions and sensations in the area, and is recommended by the AUA/SUFU guideline as a treatment option for patients with idiopathic overactive bladder who have an inadequate response to or have experienced intolerable side effects from pharmacotherapy or behavioral therapy 1.
From the Research
Sacral Neuromodulation for Urinary Retention, Fecal Incontinence, and Female Sexual Anorgasmia
- Sacral neuromodulation (SNM) has been used to treat various urological disorders, including urinary urge incontinence, urgency-frequency, nonobstructive urinary retention, and fecal incontinence 2, 3, 4, 5.
- The treatment has been shown to be effective in managing these conditions, with success rates above 70% for refractory overactive bladder syndrome and non-obstructive urinary retention 3, 6.
- SNM has also been used to treat fecal incontinence, with significant improvements in symptoms reported in several studies 3, 4, 5.
- However, there is limited evidence on the use of SNM for female sexual anorgasmia, and it is not a commonly reported indication for this treatment 2, 3, 4, 6, 5.
- The implantation procedure for SNM typically involves a two-stage process, with an initial trial phase to determine the best possible treatment response, followed by implantation of the device if the patient responds well to the trial phase 3, 6.
- The device is programmed to stimulate the sacral nerves, which can help to modulate the activity of several micturition-associated neurons in the spine, brainstem, and cerebrum, leading to improved bladder and bowel function 6.
Efficacy of Sacral Neuromodulation
- Several studies have reported significant improvements in symptoms of urinary urge incontinence, urgency-frequency, nonobstructive urinary retention, and fecal incontinence after SNM treatment 2, 3, 4, 5.
- A multicenter research project found that SNM was effective in treating refractory overactive bladder syndrome and urinary retention, with high cure rates and low complication rates 3.
- Another study reported that SNM was effective in treating fecal incontinence, with significant improvements in symptoms and quality of life 5.
Safety and Complications
- SNM is generally considered to be a safe treatment, with a low risk of serious complications 3, 6, 5.
- However, some patients may experience adverse effects such as pain at the implant site, lead migration, and infection 3, 6, 5.
- The risk of surgical revision is relatively high, with rates ranging from 12% to 21% in some studies 5.